Community Mental Health Nursing Flashcards
Public health model
Primary → secondary → tertiary [prevention]
- Inpatient to outpatient focus; consider how closure of state hospitals has affected care
Primary Prevention
- Client education = nursing focus
- Assisting individuals to increase their ability to cope effectively w/stress
- Targeting & diminishing harmful forces (stressors) within the environment
- Promotes health & prevents mental health problems from occurring
Examples of primary prevention
- Teaching parenting skills & child development to prospective new parents
- Teaching physical & psychosocial effects of alcohol/drugs to elementary school students
- Teaching techniques of stress management to virtually anyone who desires to learn
- Teaching groups of individuals ways to cope w/the changes assoc w/various maturational stages
- Teaching concepts of mental health to various groups within the community
- Providing education & support to unemployed or homeless individuals
- Providing education & support to other individuals in various transitional periods (e.g., widows & widowers, new retirees, & women entering the work force in middle life)
! Is focused on targeting the group @ risk & provision of educational programs
Secondary Prevention
- Recognition of sx’s & provision of or referral for treatment = nursing focus
- Early identification of problems - focuses on early detection of mental illness
- Prompt initiation of effective treatment to include hospitalization & crisis intervention
Examples of secondary prevention
> Ongoing assessment of individuals @ high risk for illness exacerbation (e.g., during home visits, day care, community health centers, or in any setting where screening of high-risk individuals might occur)
> Provision of care for individuals in whom illness sx’s have been assessed (e.g., individual or group counseling, med admin, education & support during period of increased stress [crisis intervention], staffing rape crisis centers, suicide hotlines, homeless shelters, shelters for abused persons, or mobile mental health units)
> Referral for treatment of individuals in whom illness sx’s have been assessed. Referrals may come from support groups, community mental health centers, emergency services, psychiatrists or psychologists, & day or partial hospitalization. Inpt therapy on a psych unit of a general hosp or in a private psychiatric hospital may be necessary. Psychopharmacology & various adjunct therapies may be initiated as part of the treatment
Tertiary Prevention
- Helping clients learn/relearn socially appropriate behaviors = nursing focus
- Prevention of complications
- Reduction of residual impairment
- Promotion of rehabilitation directed toward achievement of maximum functioning
Examples of tertiary prevention
> Consideration of the rehab process @ the time of initial dx & treatment planning
> Teaching the client daily living skills & encouraging independence to his or her maximum ability
> Referring clients for various aftercare services (e.g., support groups, day treatment programs, partial hospitalization programs, psychosocial rehab programs, group home, or other transitional housing)
> Monitoring effectiveness of aftercare services (e.g., through home health visits or follow-up appts in community mental health centers)
> Making referrals for support services when req’d (e.g., some communities have programs linking individuals w/serious mental disorders to volunteers who develop friendships w/the individuals & may assist w/household chores, shopping, & other ADLs w/which the individual is having difficulty, in addn to participating in social activities w/the individual)
Prevention in the community
Primary → secondary → tertiary [prevention]
____ prevention in the community
Nursing interventions for maturational crises
- Adolescence - support & info during transition
- Marriage - encourage communication, discuss expectations, compromise
- Parenthood - anticipatory guidance
- Midlife - support & info during changes
- Retirement - support & info re: resources
Primary
Situational crises
- Poverty
- Life changes
- Environmental conditions
- Trauma
Nursing interventions = support to maintain highest lvl of functioning & prevention of initiation or exacerbation of MI
____ prevention in the community
- Prepare those who have experienced homelessness to never have to experience it again
Tertiary
____ prevention in the community
Nursing interventions for maturational crises
- Adolescence - problem identification & stabilizing a crisis situation
- Marriage - referrals, identification of problem
- Parenthood - teach effective discipline, recognition of signs of child abuse, referrals
- Midlife - individual is unable to integrate all of the changes that are occurring
- Retirement - may be r/t depression
Secondary
Situational crises
- Poverty
- Life changes
- Environmental conditions
- Trauma
Nursing interventions = include the nursing process
Deinstitutionalization
- Closing of state mental hospitals (late 50’s, early 60’s)
- d/t inadequate funding, overcrowding, & understaffing
- resulted in the formation of crisis-type institutions to manage pts
- Discharging of individuals w/mental illness
- Introduction of psychotropic rx’s (e.g., thorazine)
Treatment Alternatives
- Community-based care
- Community mental health centers
- Case management
- Assertive Community Treatment (ACT)
- Partial hospitalization programs
- Community residential facilities
- Psychiatric home health care
Assertive Community Treatment (ACT)
- 24/7, 365; based on the idea that people receive better care when their mental healthcare providers work together
Partial hospitalization programs - day or evening
Community residential facilities
* For those w/severe & persistent mental illnesses; e.g., group homes, halfway houses, foster homes, boarding homes, shelter care facilities, transitional housing, independent living programs
Homelessness & the mentally ill
Schizophrenia contributing factors -
> deinstitutionalization
> poverty
> scarcity of affordable housing
> lack of affordable healthcare
> domestic violence
> addiction disorders
- Also, bipolar disorder, substance abuse addiction, depression, personality disorder, & neurocognitive disorders
- 40% of homeless abuse alcohol
